P03 JA CLC RAI 3.12.2024_Redacted.pdf

Control Number VA-24-00010679

JUSTIFICATION FOR OTHER THAN FULL AND OPEN COMPETITION

1. Contracting Activity: Department of Veterans Affairs (VA)

Office of Procurement, Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, NJ 07724

2. Description of Action: The proposed firm-fixed-price sole source action is for procurement of Document Storage Systems, INC. (DSS) Caribou brand name enterprise licenses, ongoing enhancements, customization, sustainment, and maintenance support for the enterprise licenses. These licenses are in support of the Veterans Health Administration’s (VHA) Geriatrics and Extended Care (GEC) Operations use of the Community Living Centers (CLC) Resident Assessment Instrument (RAI) (CLC-RAI) VASI ID # 2290. The CLC-RAI product is commercial off the shelf (COTS) software, brand name Caribou, which was developed by DSS, 12575 US Hwy 1 Suite 200, Juno Beach, FL 33408, and is currently maintained in the VA Enterprise Cloud (VAEC) Microsoft Azure Government (MAG) hosting environment.

3. Description of the Supplies or Services: VA’s, Office of Information and Technology (OIT) has a requirement to procure the renewal of 135 enterprise software licenses for DSS Caribou to include services for enhancements based on annual changes in the Center for Medicare & Medicaid Services (CMS) National Standards, VHA customizations for Administration specific Clinical Practice Guidelines, and sustainment and maintenance support of the product. This DSS Caribou product is a Nursing Home Long Term Care (LTC)/Skilled Nursing Facility (SNF) product that consists of highly customized COTS software developed, maintained, and sustained by DSS in the VAEC MAG hosting environment. The DSS Caribou product provides a scalable, automated information system in use at 135 CLCs. The solution integrates with approximately 132 instances of the Veterans Health Information Systems and Technology Architecture (VistA) and Oracle Cerner Millennium for the 5 VHA CLCs which have converted to the new VA Electronic Health Record (EHR). DSS Caribou adequately addresses the workload of approximately 11,000 users, 30,000 annual admissions, and helps to manage approximately 8,000 CLC patient beds per year. DSS also provides an enterprise license which permits expansion and the VA provision to add facilities and beds to meet Veteran demand and mission requirements with an anticipated growth rate of 3% per year. The solution provides encrypted bi-directional Health Level-7 (HL7) communication between DSS Caribou, VistA, and Oracle Cerner Millennium.

DSS Caribou software is a critical standardized assessment tool meeting legislative requirements through supporting the completion of a comprehensive, accurate, and reproducible patient assessment, and serves as the basis for developing the patient's plan of care. The DSS Caribou product is used by the VHA GEC Program Office at all of the VHA CLCs which meets the functional and technical requirements, while maintaining regulatory compliance with current CMS National Standards, all Laws, Community Living Centers Resident Assessment Instrument Control Number VA-24-00010679

Regulations, Policies, and Section 508 requirements. The DSS Caribou software is used to support the Minimum Data Set (MDS) 3.0 RAI Manual collection of data to determine workload, Veterans Equitable Resources Allocation (VERA) reimbursements, VA Care Compare Star ratings (benchmarking against the commercial Nursing Home industry for quality indicators), as well as capture resident preferences for care.

The Period of Performance for this action will be 12 months, with four 12-month option periods, and one optional task for Transition Out. The total estimated value for this contract is

4. Statutory Authority: The statutory authority permitting other than full and open competition is 41 U.S.C. 3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) 6.302-1 entitled, “Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements.”

5. Rationale Supporting Use of Authority Cited Above: No other software license can meet VA’s interoperability or compatibility requirements. Specifically, DSS, VistA, and Oracle Cerner Millennium have each undergone significant development and configuration work to allow interoperability with the DSS Caribou software and enterprise license. No other brand name software can meet these critical VA requirements without extensive redevelopment, reconfiguration, and redesign efforts causing extensive estimated delivery delays in excess of 18 months and total estimated duplicated costs of approximately $5 million. Specifically, use of any other brand name software would result in not being able to transmit data and communicate with VistA and Oracle Cerner Millennium. DSS Caribou software and interfaces have been extensively customized to work with VistA and Oracle Cerner Millennium to include both HL7 v2.x ADT and HL7 Fast Healthcare Interoperability Resources (FHIR) R4 RESTful webservices for progress note writeback and e-signature. If any other brand name software were to be utilized, all of the very complex, costly, and time-consuming HL7 v2.x and FHIR interfaces would need to be redeveloped, requiring thousands of lines of source code to be rewritten and thoroughly tested for this Veteran patient care critical mission system. VA estimates that this part alone would create extensive redevelopment and reconfiguration effort and would result in in duplicated costs that would not be recovered through competition. These estimates are based on similar redevelopment and reconfiguration efforts. Additionally, no other product can meet VA’s compatibility requirements as it relates to integration with VA’s Identity and Access Management (IAM) Single sign-on internal (SSOi) Personal Identity Verification (PIV) Card Active Directory (AD) and Open Authorization

2.0 authentication and authorization services. PIV Card integration requires an exceedingly complex effort based on the X.509 public key infrastructure standards and VA IAM SSOi design patterns. Any other brand name software would have to also require integration with the 132 instances of VistA role-based access control Verify and Access and Oracle Cerner Millennium for certificate-based e-signatures written back to the patient’s medical record. VA estimates that this extensive PIV Card redevelopment and reconfiguration effort would require 12 months and produce approximately $1 million in duplicated costs that would not be recovered through competition. These SSOi PIV Card estimates are also based on similar redevelopment and reconfiguration efforts. Also, no other brand name software can meet all of VA’s functional and interoperability requirements. Specifically, VA requires customization of the MDS RAI Section S Item Set for 20 CLC treating specialties that are mapped differently at each medical center, Resource Utilization Group (RUG), and VHA unique business process/workflow that does not align with CMS MDS National Standards as VHA does not submit MDS batch files to CMS for Medicare Medicaid reimbursement. This customization of DSS Caribou allows for VHA-only clinical practice guidelines and unique reporting requirements for VERA workload, resources, and reimbursements. No other brand name product can provide this critical functionality. Failure to have this functionality will result in inaccurate data capture at point of care, improper clinical reporting, and incorrect interdisciplinary clinical case mix assignment and staffing at 135 CLCs across the entire VA.

VA requires a sole source renewal of the DSS Caribou contract, with minor modification, to update the requirements according to current processes. To successfully carry out its mission and due to the highly technical nature of the work being performed under this contract, it is necessary that any contractor other than DSS would need access to the current DSS Caribou proprietary data. The expertise must also include knowledge of the operating environment, including an understanding of the coding specifications, the functionality, and all interoperability requirements between the highly customized applications. DSS Caribou software enhancements are based on annual changes in the CMS National Standards, VHA customizations for Administration specific Clinical Practice Guidelines, and sustainment and maintenance which can only be provided by DSS. DSS owns the Technical Data Package (TDP), Intellectual Property (IP) rights, proprietary source code for the DSS Caribou software, and the highly customized and tightly integrated DSS Caribou interface with both VistA and Oracle Cerner Millennium.

Any other vendor/source providing software enhancements, sustainment, and maintenance for DSS Caribou would need access to the inner workings of the DSS Caribou TDP, IP, and source code to provide updates, modifications, enhancements, and security patches to the software, which only DSS currently provides. These services are needed to ensure that the DSS Caribou software is properly configured.

Any other vendor/source would result in a lack of needed support for sustainment and maintenance and negatively impact more than 11,000 current DSS Caribou software users (VHA Providers) and 8,000 Veterans residing in VHA CLCs. During this time, resident assessments and care plans would not be available which would very negatively impact patient care. CLC multidisciplinary provider productivity would be reduced, and essential MDS specific operational reporting would not be possible.

VA technical experts initially engaged in preliminary discussions with DSS regarding the DSS Caribou TDP/IP but subsequently decided it is not in line with VA’s plans to replace DSS Caribou with a competitive process utilizing other Nursing Home LTC/SNF COTS solutions.

OIT requires DSS Caribou support for a minimum of five years. The 12-month base period and four 12-month option periods would be exercised at the government’s discretion. This 5-year duration will allow the government to seek appropriate funding, perform the necessary acquisition work, award a more competitive contract, integrate, test, train, and deploy the new Nursing Home LTC/SNF COTS software product and replace DSS Caribou. As mentioned previously, this timeline for fiscal requests to support a replacement enhanced COTS product, and allowances to sustain the existing licenses and support, would not be achievable until at least FY26 for initial award, followed by a projected 12-18 months for verification and testing and release. The migration to a Nursing Home LTC/SNF COTS will allow VHA to move off of the antiquated, no longer used, unsupported RUG staffing methodology and onto the current CMS National and Industry Standard Patient Driven Payment Model (PDPM) that is baked into all Nursing Home LTC/SNF COTS products and used by all CMS certified Nursing Home LTC/SNF due to mandatory changes in Federal Laws, Regulations, and Policies. This 5-year period will support VHA’s business new service request process through a planned migration off of the DSS Caribou product and onto a Nursing Home LTC/SNF COTS software used by the majority of commercial and private Nursing Homes throughout the US, in accordance with VHA/OIT ServiceNow Demand DMND0008919: TA/CE: WC20230634 Potential COTS Replacement for DSS Caribou (Bath VAMC).

On June 5, 2017, VA announced its decision to replace legacy VistA with the Oracle Cerner Millennium EHR solution to align with the Department of Defense (DoD) Military Health System GENESIS EHR. This strategy aims to create a single, accurate, lifetime health record that will facilitate the seamless transition of Active-Duty service members to Veteran status and promote meaningful use and sharing of health data with community partners. This will also increase compatibility and streamline integration with the Electronic Health Record Modernization driven Oracle Cerner Millennium CareTracker and Revenue Cycle applications currently in use at five VHA CLCs today.

Based on the above confirmation of DSS proprietary data rights, and knowing there are no other vendors able to modify the DSS Caribou software or software code without access to DSS IP and proprietary source code, it is recommended this sole source procurement be utilized to continue the license and support services required.

6. Efforts to Obtain Competition: Market research was conducted, the details of which are in the market research section of this document. This effort did not yield any additional sources that could meet the Government’s requirements. There is no competition anticipated for this acquisition. Additionally, the proposed action will be synopsized on the Contracting Opportunities Page in accordance with FAR 5.201. Any proposals that are received shall be evaluated.

7. Actions to Increase Competition: VA technical and functional experts are taking actionable steps to increase competition by conducting market research and drafting requirements for a more competitive Nursing Home LTC/SNF COTS solicitation in FY26 Q3 or Q4, followed by a transition period that will allow for integration, testing, training, and deployment of a newly awarded competitive Nursing Home LTC/SNF

COTS.

If that competitive contract and product is in place prior to exercising an optional period on this DSS Caribou contract, VA will not exercise the option and instead transition to the competitive Nursing Home LTC/SNF COTS contract and product.

8. Market Research: The Government’s technical experts performed market research on October 10, 2023, with a request for information (RFI) on SAM.gov for a replacement of the current DSS Caribou product. A total of three vendors provided a response to the RFI: SRR International, Inc., Unico Government Solutions, LLC, and DSS.

SRR International, Inc., and Unico Government Solutions, LLC, responded to this RFI by providing only their respective company Capability Statements that did not provide any details demonstrating that the companies could meet any of VA’s requirements as outlined in Section 5 of this justification. Furthermore, neither company provided any information that they even possessed a Nursing Home LTC/SNF COTS software product.

The DSS RFI response demonstrated that its product currently meets all functional and interoperability requirements as stated in Section 5 above.

The RFI did not produce any viable candidate software products that could currently replace the existing DSS Caribou product. The technical team will conduct further market research and refine the requirements for a Nursing Home LTC/SNF COTS software product to eventually replace DSS Caribou.

VA technical experts conducted additional market research through multiple exhaustive internet searches in 2024, collecting and analyzing Nursing Home LTC/SNF COTS software products and service data using Google, Capterra, KLAS, GSA Advantage, System for Award Management, Electronic Contract Management System, Federal Procurement Data System-Next Generation, the Office of Small and Disadvantaged Business Utilization Small Business Administration’s Veteran Small Business Certification database, and many other commercial and government web sites to ascertain if there were any other sources that could meet the Government’s requirement for brand name DSS Caribou software enhancement, sustainment, and maintenance support services. No other sources were found that could meet the Government’s brand name requirement.

In January 2024 an internet search of several commercial marketplace intermediary websites, (including Capterra and EMRFinder), for products and services similar to DSS Caribou found the following four top rated Nursing Home LTC/ SNF COTS software packages: PointClickCare, MatrixCare, Experience Care’s NetSolutions, and Netsmart.

The research concluded that although other Nursing Home LTC/SNF software products exist, none have the proprietary software interface that would be required to connect with both VistA and Oracle Cerner Millennium. As noted, integration with VistA and

Oracle Cerner Millennium is a significant requirement for VHA CLCs, and acquiring the necessary coding, testing, and approval to integrate a new product to VistA and Oracle Cerner Millennium is anticipated to take a year. During this time, resident assessments and care plans would not be available and would negatively impact both patient care quantity and quality. CLC multidisciplinary provider productivity would be reduced, and essential MDS specific operational reporting would not be possible. Additionally, the technical experts reviewed the maintenance services provided by other commercial software providers. None of the vendors reviewed had the ability to provide the sustainment and maintenance support services for the highly customized DSS Caribou software with interfaces to both VistA and Oracle Cerner Millennium.

Based on the extensive market research set forth above, the Government's technical experts determined that only DSS's Caribou software, sustainment, and maintenance support services can meet all of the Government's technical requirements and that DSS is currently the only responsible source as it is the developer and sole provider of the DSS Caribou software and associated maintenance and support services.

9. Other Facts: None.